Clinical outcomes and prognostic factors of transcatheter aortic valve implantation in bicuspid aortic valve patients

Yoon, Sung‐Han; Sharma, Rahul; Chakravarty, Tarun; Kawamori, Hiroyuki; Maeno, Yoshio; Miyamoto, Masaki; Nomura, Takahiro; Ochiai, Tomoki; Israr, Sharjeel; Rami, Tanya; Nakamura, Mamoo; Chen, Wen; Makkar, Raj

doi:10.21037/acs.2017.09.03

Cited by 20 publications

(25 citation statements)

References 39 publications

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“…Yoon et al found similar new permanent pacemaker insertion rates between early‐generation (13.1%) and new‐generation (16.7%) valves . However, post‐TAVR pacemaker implantation rate decreased to 12% with no difference between early‐ (8.8%) and new‐generation (13.5%) valves in their most recent study ( P = 0.49), consistent with the finding in our current study. Another study including 51 patients with BAV who underwent TAVR with the SAPIEN 3 valve reported a 23.5% rate of new pacemaker implantation after TAVR .…”

Section: Discussionsupporting

confidence: 91%

“…In a study by Yoon et al, moderate to severe PVL was detected in up to 20% of patients who underwent TAVR with an early‐generation valve . They later found significantly higher rates of moderate or greater than moderate PVL in BAV patients who underwent TAVR with an early‐generation valve compared to those who had TAVR with a new‐generation device, 14.7% versus 2.7% ( P = 0.03) . Perlman et al did not find any patient with moderate or severe aortic regurgitation after TAVR in BAV patients using the SAPIEN 3 valve .…”

Section: Discussionmentioning

confidence: 98%

“…15 The literature suggests that the stroke rate in patients with BAV is not statistically higher and valve generation does not play a pivotal role in postoperative stroke rate. 12 Further studies should continue to carefully examine stroke rate to identify any increased risk in BAV patients.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Later reports using new generation valves showed promising results with less PVL and fewer postprocedural complications. [12][13][14][15][16] There are limited data regarding outcomes of TAVR in patients with BAV and the majority of these studies have not considered a control group of patients with trileaflet aortic valve stenosis. 12 Patients with BAV tend to develop symptomatic AS at a younger age.…”

mentioning

confidence: 99%

“…[12][13][14][15][16] There are limited data regarding outcomes of TAVR in patients with BAV and the majority of these studies have not considered a control group of patients with trileaflet aortic valve stenosis. 12 Patients with BAV tend to develop symptomatic AS at a younger age. The application of TAVR technology has now been expanded to intermediate-risk patients, and potentially low-risk patients in the future.…”

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confidence: 99%

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Early and midterm outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valves

et al. 2018

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Early and midterm outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valves

et al. 2018

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Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study

Attinger‐Toller

Bhindi

Perlman

et al. 2019

Cathet Cardio Intervent

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Objectives: To perform clinical and echocardiographic follow-up beyond 1 year in consecutive patients with severe bicuspid aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with a current generation balloon-expandable valve.Background: Treatment of bicuspid aortic valve disease with TAVR remains controversial and late follow-up data is still scarce. Methods:We collected baseline characteristics, procedural data, 30-day and midterm clinical follow-up findings from six centers in Europe and Canada from patients with bicuspid AS treated with TAVR using the SAPIEN 3 valve.Results: Seventy-nine patients underwent TAVR. Mean age was 76 ± 9 years; median STS risk score for mortality was 3.8% (interquartile range 2.3-5.5%). Median follow-up was 390 days (interquartile range 138-739 days). Device success was achieved in 95% of patients. Postimplantation mean aortic gradient decreased from 50.2 ± 16.2 to 8.8 ± 4.4 mmHg and no patient had more than mild aortic regurgitation. At last follow-up, there was persistent good valve performance. At 30 days and 1 year, the rates of allcause mortality were 3.8 and 7.7%, stroke 1.2 and 1.2%, and the rate of new pacemakers 18 and 18%.Conclusions: Our data confirm that treating patients with stenotic bicuspid aortic valves is safe, effective, and has favorable valve performance over time.aortic valve disease percutaneous intervention, paravalvular leak, structural heart disease intervention, transcatheter valve implantation Transcatheter aortic valve replacement (TAVR) has emerged as the preferred treatment modality for many patients with severe aortic stenosis (AS). 1-6 However, the great majority of data demonstrating efficacy and safety of TAVR derives from patients with tricuspid aortic valve morphology. Treatment of bicuspid aortic valve (BAV) disease with TAVR remains controversial. 7 BAV is a heritable defect found in 0.5-2% of the population. [8][9][10] Due to younger age at presentation and anatomical complexity, bicuspid AS has been excluded from major randomized trials comparing TAVR to surgical aortic valve replacement (SAVR). However, 2-6% of patients in large clinical registries have bicuspid AS. 11,12 Anatomical challenges associated with BAV include larger aortic annuli, severe and asymmetric leaflet and annular calcification, altered geometry, and dilation of the ascending aorta. 9,[13][14][15] In 2010, the first series of patients with BAV treated with early TAVR devices confirmed feasibility. 16 Typically, residual aortic regurgitation (AR) and periprocedural complications have been more common in patients with bicuspid AS undergoing TAVR. [16][17][18][19] However, this data is based on observational studies, in most of which, early generation devices were used. Perlman et al 20 demonstrated favorable periprocedural and 30-day outcomes in patients with BAV undergoing TAVR with the SAPIEN 3 valve, suggesting superior results with newergeneration devices. Subsequently, Yoon et al demonstrated improved procedural outcomes with the SAPIEN 3 val...

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Preoperative Evaluation: Indications and Risk Analysis

Watkins

Gupta

Griffith

2018

Transcatheter Aortic Valve Replacement

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Clinical outcomes and prognostic factors of transcatheter aortic valve implantation in bicuspid aortic valve patients

Cited by 20 publications

References 39 publications

Early and midterm outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valves

Early and midterm outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valves

Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study

Preoperative Evaluation: Indications and Risk Analysis

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